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NCLEX Review (by M.K.) > Drug Toxicities, Bilirubin, Kernicterus, Dumping/HH, Hyperkalemia > Flashcards

Drug Toxicities, Bilirubin, Kernicterus, Dumping/HH, Hyperkalemia Flashcards

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1
Q

Used for Bipolar, specifically for manic episodes but not for the depression

What it its
Therepeutic level:
Toxic level:

A

LITHIUM (antimania drug)

Therepeutic level: 0.6 to 1.2
Toxic level: > 2.0

*Notice gray area: 1.3-2

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2
Q

Used to treat A-Fib and CHF

What are its
Therepeutic level:
Toxic level:

A

LANOXIN or DIGOXIN

Therepeutic level: 1 to 2
Toxic level: >2

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3
Q

Used for muscle spasm relaxer for the airway
- compound of the bronchodilator theophylline
*actually NOT a bronchodilator, only relaxes spasms
B2 -> relaxes spasms
*bronchodilators should be given AFTER antispasmotic to relax the airway first THEN dilate

What is its
Therapeutic level:
Toxic level:

Non-therapeutic level:

A

AMINOPHYLLINE

What is its
Therapeutic level: 10 to 20
Toxic level: > 20

Non-therapeutic level: < 10… if it is ot therapeutic, increase dose of medication, and assess for compliance

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4
Q

Seizure medication

What is its
Therapeutic level:
Toxic level:

A

DILANTIN (PHENYTOIN)

Therapeutic level: 10-20
Toxic: level: >20

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5
Q

Breakdown product of Red Blood Cells

What is its
Elevated level: ___________________
Toxicity: _________________

When do physicians want to hospitalize these newborns?
Level: __________________

A

BLILIRUBIN

Elevated level: 10 to 20
Toxicity: >20

*always tested in the newborns on the NCLEX

When do physicians want to hospitalize these newborns?
Level: when the bilirubin level is 14 to 15

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6
Q

When there is excess bilirubin in the brain
It occurs when bilirubin level in blood gets _____________

In the brain, it may cause aseptic (sterile) meningitis or encepalopathy (don’t need to know)
IT CAN BE DEADLY

A

Kernenicterus

> 20

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7
Q

• Position the newborn assume due to irritation of the meninges from kernicterus
• Presentation: hyperextended posture … (Is a medical emergency)

A

Opisthotonoc

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8
Q

In what position do you place an opisthotonic newborn?

*Opisthotonic: Position the newborn assume due to irritation of the meninges from kernicterus

A

Put them on the side

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9
Q

It is when the newborn comes out yellow, something is wrong

A

Pathologic jaundice

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10
Q

It is when the newborn turn yellow 2 to 3 days postpartum, that’s ok

A

Physiologic jaundice

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11
Q

What are gastric emptying problems and are opposites

A

Dumping Syndrome vs. Hiatal Hernia

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12
Q

• Regurgitation of gastric acid upward or backward into esophagus
• “Like a cow with 2 stomachs,” gastric contents go in wrong direction at the correct rate
• S/Sx of hiatal hernia is similar to GERD (Heartburn and indigestion)
• S/Sx of hiatal hernia = S/Sx of GERD when LYING DOWN AFTER A MEAL (THIS DISTINGUISHES ____ from GERD)
- in other words, Heartburn, Indigestion on lying down after eating

*it is GERD after you lie down and eat

A

HIATAL HERNIA

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13
Q

What is the treatment of HIATAL HERNIA

A
  1. Elevate HOB (head of bed) during and 1 hour after meals
  2. Increase the amount of fluids with meals
  3. Increase the amount of Carb content
  • these cause the stoamach to empy quickly so its content doesn’t back up
    0High-ata Hernia…. Everything high
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14
Q

• Gastric contents are dumped too quickly into duodenum
o Right direction but at wrong rate • S/Sx of dumping syndrome
o Drunk: Staggering gate, impaired judgment, labile—all blood gone to gut
o Also get Shock: cold/clammy, tachycardia, pale
o Now add Acute abdominal distress: n/v, diarrhea, cramping, guarding, borborygmi,
bloating, distention • Dumping syndrome = Drunk, Shock, Acute Abdominal Distress (r/t to dehydration)

A

Dumping syndrome

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15
Q

What are the S/Sx of dumping syndrome

A

o Drunk: Staggering gate, impaired judgment, labile—all blood gone to gut
o Also get Shock: cold/clammy, tachycardia, pale
o Now add Acute abdominal distress: n/v, diarrhea, cramping, guarding, borborygmi, bloating, distention

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16
Q

Drunk + Shock

A

Hypoglycemia

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17
Q

Drunk + Shock + Acute abdominal distress

A

Dumping syndrome

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18
Q

What is the Tx of Dumping Syndrome?

A

•Can do 3 things, as shown below
1. Lower HOB (head of bed) during meals and turn pt on the side
2. Decrease the amount of fluids 1 or 2 hours before or after meals
3. Decrease the amount of Carb content
o These 3 things prevent the stomach to empty quickly or dump its content into the duodenum
• Dumping syndrome … Everything low

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19
Q

• Protein does the opposite of carbohydrate
• Protein bulks gastric content, takes longer to digest, and moves slower through the gut
• Therefore, give

Do we give low or high protein in HIATAL HERNIA?

A

LOW

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20
Q

• Protein does the opposite of carbohydrate
• Protein bulks gastric content, takes longer to digest, and moves slower through the gut
• Therefore, give

Do we give low or high protein for DUMPING SYNDROME?

A

HIGH

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21
Q

Go in the same direction as the prefix, except for HR and urine output (UO), which go in the opposite direction

A

Kalemia(s)

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22
Q

What does HYPOkalemia look like

A

Symptoms go low with hypo, except UO and HR

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23
Q

What does HYPERkalemia look like?

A

Symptoms go high with hyper, except HR and UP

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24
Q

List the S/Sx of Hyperkalemia

A

Brain: seizures, agitation, irritability, loud down
Heart: tented T waves, ST elevated, decrease HR
Bowel: diarrhea, borborygmi
Muscle: spasticity, increase tone, hyperreflexia (3+, 4+)
UO: down (oligouria)
Lungs: Tachypnea

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25
Q

WHAT IS THE Tx OF HYPERKALEMIA

A

KAYEXALATE

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26
Q

What are S/Sx of Hypokalemia

A

Lethargy, bradypnea, paralytic ileus, constipation, muscle faccidity, hyporeflexia (0, 1+)
TACHYCARDIA (HR is up)
POLYURIA (UO is up)

27
Q

WHAT IS THE TX FOR HYPOKALEMIA

A

PO K LYTE Replacement

K absorbs best via GI

28
Q

Your patient has hyperkalemia, select all that apply
A. Adynamic ileus
b. Obtunded
c. 1+ reflex
d. Clonus (irritable)
e. U wave
f. Depressed ST
g. Polyuria
h. Bradycardia

A

D.
H.

*hyperkalemia has tented T wave, T wave peak

29
Q

What does Calcemia(s) look like

A

GO IN OPPOSITE DIRECTION AS THE PREFIX

30
Q

Symptoms go (high or low) ______________ with hypocalcemia

A

HIGH

31
Q

Symptoms go (high or low) ______________ with hypercalcemia

A

LOW

32
Q

What to do with kids w biluribin of 11-13

A

Sunlight, Fluids

33
Q

What bilirubin level does doctors consider bringing newborns to hospital

A

14-15

34
Q

Gastric problem where The direction is the problem, at the correct rate

A

Hiatal hernia

35
Q

Gastric contents dump too quickly to the duodenum

A

Dumping syndrome

36
Q

Is it hiatal hernia or gerd?

A nurse get up in the morning skips bfast passes meds does tx, at 11:00 have epigastric pain, indigestion, etc

A

GERD

37
Q

Gerd or hiatal hernia?

Nurse gets home at 7pm eats and lies down. later develops epigastric pain, etc

A

GERD

38
Q

What are s/Sx of Hypercalcemia

A

Bradycardia, bradypnea, flaccid, hypoactive reflexes, lethargy, constipation, etc

39
Q

What are S/Sx of Hypocalcemia?

A

Agitation, irritability, 3+ or 4+ reflexes, spasm, seizure, tachycardia, Chvostek sign (tap the cheek), Trossseau (inflate BP cuff)= hand spasm with BP cuff, etc

40
Q

For potassium, pick answers related to __________ problems

A

Heart

41
Q

For calcium, pick answers related to ______ problems

A

Muscle

42
Q

Choose the electrolyte ______________ is nerve or skeletal involvement

A

CALCIUM

43
Q

Your patient has diarrhea … Which one of the following electrolyte imbalances causes diarrhea?

A

Hyperkalemia

44
Q

What dpes hypernatremia looks like? S/Sx?

A

Dehydration, high Na in the blood vessels pulls flui from body into the vasculature
- hot, fluched, dry skin, thready pulse, rapid HR… Give fluid
- associate “E” in hypernatremia with DEhydration

45
Q

What does Hyponatremia looks like? What are S/Sx?

A

Overload

  • crackles, distended neck veins….
    *Associate “O” in hyponatremia with Overload
46
Q

What is the nursing diagnosis for hyponatremia?

A

Fluid Volume Excess

47
Q

What is the Tx for HYPONATREMIA

A

Fluid restriction & Lasix

48
Q

What is the Tx for Hypernatremia

A

Give fluid

49
Q

In addition to a high potassium, what other electrolyte abnormality can be seen in DKA?

A

Sodium (Na)
/Hypernatremia

50
Q

Review—Think dehydration or Fluid overload

SIADH: Hyponatremia

SIADH:
DI:
HHNK:

A

SIADH: Hyponatremia (dehydration)
DI: Hypernatremia (fluid overload)
HHNK: Hypernatremia (dehydration)

51
Q

What is the universal sign of all electrolyte imbalance?

A

Muscle weakness = Paresis

52
Q

What are the early sign of any electrolyte disturbance?

A

Numbness and tingling = Paresthesia
Circumoral paresthesia = Numbness and tingling around the lips

53
Q

What is the rule in administration of Potassium IV

A

NEVER GIVE PUSH

54
Q

How do we treat HYPERKALEMIA

A

• The fastest way to lower potassium level is to
o Give D5W and regular insulin to decrease potassium o This will drive the potassium into the cell and out of the blood o Temporary solution but quick
• Kayexalate is long-term solution
o Through enema or ingestion, Kayexalate exchanges potassium for sodium

o Potassium is eliminated through feces and pt becomes hypernatremic
o Hypernatremia is managed with IV fluid administration
o The downside is it takes hours to work

• To solve this problem
o Give D5W, Regular insulin, and Kayexalate and the same time
D5W and Regular insulin work instantly
Kayexalate works in a few hours—K Exits Late

55
Q

Of all electrolyte imbalance, high ________ is the most problematic
High ________ can stop the heart

A

POTASSIUM

56
Q

What is normal potassium levels

A

3.6 to 5.2

57
Q

A sign of neuromuscular irritability due to low calcium

A

Chvostek sign

58
Q

Hand spasm with BP cuff due to low Calcium

A

Trousseau

59
Q

What are signs of hypocalcemia

A

Chvostek sign (tap the cheek)
Trosseau (inflate BP)
Agitation
Irritability
3+ 4+ reflexes
spasm
seizure
Tachycardia

60
Q

What are released in thyroid

A

Thyrpid hormones

Replace w: Levothyroxine if Hypothyroidism /myxedema coma

61
Q

What are Adrenal hormones?

A
  1. Epinephrine
  2. Cortisol (high blood glucose)
  3. Aldosterone (high Sodium, low Potassium)
62
Q

A.k.a. Hypoadrenalism or adrenal insufficiency

A

Addison Disease

63
Q

Under secretion of steroids(stress hormone) ((they are a time bomb!))
S/SxL pts are hyperpigmented (very tan)
They do not adapt to stress (decrease of perfusion to the brain)

A

Addison Diseases (hypoadrenalism/ adrenal insuffeciency)

NCLEX Review (by M.K.) (21 decks)

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